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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date OFFICE USE ONLy <br />To:San Joaquin County <br />Department of Public Works <br />{Jl(CI'R-,(";4;'r ,rke-Mr <br />(Applicant Name) <br />41:,.1-1 D Wr<l-C If) <br />(Mailing Address) <br />';Stnr1cAv-CJIJ q<)Lo tf <br />(City,State,Zip Code) <br />t16\c 3/ftJ -I 7u,1 <br />(Area Code -Telephone Number) <br />JOB# <br />APN <br />EXP,DATE <br />VALID <br />STREET <br />AREA <br />TYPE <br />FORMS <br />NOTES <br />Sketch (Detailed plans'may be submitted) <br />StU'-1)==r/7IJe-fit£.1)Sr:{3'1Z:-I..} <br />'i1...V.L 5:>L(subje.cf to pavement 'cuts shall ree-eive an <br />(i)-inch aspholt concrete overlay from"the centerHne (or Lane <br />li,ne)to t-he edeg of the trav-al way as per t~e ~an JoaquinCountyTrenchCutPolicy,If the pavement IS dJslurbe~on bothsidesofthecenterline(or adjacent lone),then the entrreroqdway(or affected lon-as)sholl be resurfaced.Co.nlrac-forshallgrindandoverlaywithin10warkin',g days of per~a!1enttrenchpaving.ShouLder areas sho,11be brought up to fInishgradeasdirectedbytheC,ounty. <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br />the -r-side of S,/;1//1>de---.,fu .approximately 'Scb ~mile 56£ <br />of :":>h~'by performing t e following work (description of work): <br />~k 'v <br />Work will commence on or about _Q~M~~/_(:~for approximately _~9~(_)~days, <br />I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br />work describe e in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />E:\pua.sV.WKlMl\8TERPSlENCROACHMENT PERMff APPliCATION.DOC (01/ll8) <br />Date